右半结肠癌根治术后吻合口瘘发生危险因素及预测效能分析

Risk factors and predictive efficacy of anastomotic fistula after radical right hemicolectomy

目的探讨右半结肠癌根治术后吻合口瘘发生的危险因素,进一步评估相关因素的预测效能。方法回顾性纳入2020年1月至2024年1月于江门市中心医院接受右半结肠癌根治术治疗的患者467例,根据术后是否发生吻合口瘘分组;采用单因素和多因素法分析右半结肠癌根治术后吻合口瘘发生独立危险因素,受试者工作特征(ROC)曲线评估各因素对术后吻合口瘘发生风险的预测效能。结果本研究纳入的467例患者术后发生吻合口瘘50例,发生率为10.71%。多因素logistic回归分析结果显示肿瘤最大径>5 cm、营养风险筛查2002(NRS2002)评分≥3分及术后白蛋白水平<30 g/L均是右半结肠癌根治术后吻合口瘘发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,肿瘤最大径、NRS2002评分、术后白蛋白水平及回归模型预测概率用于右半结肠癌根治术后吻合口瘘发生风险预测曲线下面积分别为0.63、0.71、0.68、0.88。结论右半结肠癌根治术后吻合口瘘发生可能与肿瘤最大径、NRS2002评分、术后白蛋白水平有关;而基于上述危险因素构建回归模型能够准确预测患者术后吻合口瘘发生风险。

Objective To explore the risk factors for the occurrence of anastomotic fistula after radical right hemicolectomy,and to further assess the predictive efficacy of related factors.Methods A total of 467 patients who underwent radical right hemicolectomy for colon cancer at Jiangmen Central Hospital from January 2020 to January 2024 were retrospectively included and grouped according to the occurrence of anastomotic fistula in the postoperative period.Independent risk factors for the occurrence of anastomotic fistula after radical right hemicolonic cancer were analyzed by univariate and multivariate methods,and the predictive efficacy of the various factors on the risk of anastomotic fistula after the surgery was assessed by receiver operating characteristic(ROC)curve.Results Fifty cases of anastomotic fistula occurred after surgery in 467 patients included in this study,with an incidence rate of 10.71%.The results of multifactorial logistic regression analysis showed that the maximum diameter of the tumor>5 cm,the Nutritional Risk Screening 2002(NRS2002)score≥3,and the postoperative albumin level<30 g/L were the independent risk factors for the occurrence of anastomotic fistula after right hemicolectomy(P<0.05).The ROC curve analysis results showed that the maximum diameter of the tumor,NRS2002 score,postoperative albumin level and the predicted probability of the regression model for the risk of anastomotic fistula after radical right hemicolectomy were 0.63,0.71,0.68,0.88,respectively.Conclusion The occurrence of anastomotic fistula after radical right hemicolectomy may be related to the maximum diameter of the tumor,the NRS2002 score and the postoperative albumin level,and the construction of a regression model based on the above risk factors can accurately predict the risk of postoperative anastomotic fistula.